Roberto Ferraresi1, Meneme Hamade2, Vito Gallicchio2, Nicola Troisi3, Giovanni Mauri4. 1. Peripheral Interventional Unit, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, Bergamo, Italy. ferraresi.md@gmail.com. 2. Unit of Vascular Surgery, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, Bergamo, Italy. 3. Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, P.zza Santa Maria Nuova, 1, Florence, Italy. 4. Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, , P.zza Edmondo Malan 1, Italy.
Abstract
OBJECTIVES: To describe the hydrodynamic boost (HB) technique and report our preliminary results with this technique in the subintimal angioplasty of below-the-knee vessels. METHODS: HB was used in 23 cases (14 males, mean age 73 ± 12 years) of critical limb ischemia, with long chronic total occlusion of tibial arteries extended to the ankle level. The operator performs a manual injection of diluted contrast dye through a 4 F catheter into the subintimal space, close to the patent true distal lumen, in order to achieve a tear in the intimal flap and a connection with the true lumen. RESULTS: In 19/23 (83 %) cases, the HB was effective in creating a connection between the subintimal space and the true distal lumen and it was possible to advance a wire and to conclude the procedure. In 4/23 (17 %) lesions, the HB failed and the procedure was successfully completed by retrograde approach. No major complications occurred. Mean length between catheter tip and re-entry point was 8 ± 5 mm. CONCLUSIONS: HB seems to be a feasible, safe and effective re-entry technique in distal below-the-knee vessels. This method represents an easy option for re-entry that extends the possibility of antegrade approach to obtain a successful revascularization. KEY POINTS: • In subintimal angioplasty of below-the-knee vessel re-entry can represent a challenge. • Inability to re-enter may determine the failure of the revascularization procedure. • HB is a novel re-entry technique feasible in distal below-the-knee vessels. • HB may increase the success rate of antegrade approach. • In case of failure, retrograde approach remains feasible.
OBJECTIVES: To describe the hydrodynamic boost (HB) technique and report our preliminary results with this technique in the subintimal angioplasty of below-the-knee vessels. METHODS: HB was used in 23 cases (14 males, mean age 73 ± 12 years) of critical limb ischemia, with long chronic total occlusion of tibial arteries extended to the ankle level. The operator performs a manual injection of diluted contrast dye through a 4 F catheter into the subintimal space, close to the patent true distal lumen, in order to achieve a tear in the intimal flap and a connection with the true lumen. RESULTS: In 19/23 (83 %) cases, the HB was effective in creating a connection between the subintimal space and the true distal lumen and it was possible to advance a wire and to conclude the procedure. In 4/23 (17 %) lesions, the HB failed and the procedure was successfully completed by retrograde approach. No major complications occurred. Mean length between catheter tip and re-entry point was 8 ± 5 mm. CONCLUSIONS: HB seems to be a feasible, safe and effective re-entry technique in distal below-the-knee vessels. This method represents an easy option for re-entry that extends the possibility of antegrade approach to obtain a successful revascularization. KEY POINTS: • In subintimal angioplasty of below-the-knee vessel re-entry can represent a challenge. • Inability to re-enter may determine the failure of the revascularization procedure. • HB is a novel re-entry technique feasible in distal below-the-knee vessels. • HB may increase the success rate of antegrade approach. • In case of failure, retrograde approach remains feasible.
Authors: Klaus A Hausegger; Borjana Georgieva; Horst Portugaller; Josef Tauss; Gerhard Stark Journal: Cardiovasc Intervent Radiol Date: 2004 Jan-Feb Impact factor: 2.740
Authors: Rosemarie Met; Krijn P Van Lienden; Mark J W Koelemay; Shandra Bipat; Dink A Legemate; Jim A Reekers Journal: Cardiovasc Intervent Radiol Date: 2008-04-15 Impact factor: 2.740